Provider Demographics
NPI:1336319342
Name:GEISLER, JUSTIN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:THOMAS
Last Name:GEISLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 GRAVIER 7TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:MP
Mailing Address - Zip Code:70112-2272
Mailing Address - Country:US
Mailing Address - Phone:504-568-5600
Mailing Address - Fax:
Practice Address - Street 1:2020 GRAVIER ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2272
Practice Address - Country:US
Practice Address - Phone:504-568-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA205021207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1507849Medicaid
LAP01136995OtherRAILROAD MEDICARE
LA4Q688CQ60Medicare PIN